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Beyond Zoladex?

User
Posted 23 Feb 2022 at 23:09

Apologies if this has been covered elsewhere, but I wondered if anyone had a view or information regarding any "better' hormone treatment emerging over the last few years.  I had combined Chemotherapy/Zoladex in 2016 (surgery & salvage radiotherapy earlier), with the Zoladex therapy continuing 3-monthly thereafter. No complaints about the core result of the treatment as it has kept me alive, but the side-effects are tiresome and seem to worsen with age.  

I know the effectiveness of Chemotherapy/Zoladex combo was established following 2 long-term studies, so I won't be casually discarding it. However, before I discuss it with my Consultant I would welcome other views

 

User
Posted 24 Feb 2022 at 16:01
Is your PSA on the rise?

Are you only on Zoladex now?

If the Zoladex is still keeping the PSA down then I suggest you tolerate the side effects.

User
Posted 24 Feb 2022 at 18:50
Thanks Exbus. Zoladex is the only ongoing treatment i receive and (in combination with the 2016 chemotherapy) it has kept my PSA low & stable, so I won't be abandoning it as a treatment unless there is something better available. Thats why I wondered if anyone has had experience of any (more recently developed) alternative hormone therapies.
User
Posted 24 Feb 2022 at 19:39

There are no new drugs in the range of GnRH Agonists. Most (possibly all) of the side effects are due to very low Testosterone levels, and that is still the mainstay of systemic treatment.

There are a couple of potential new hormone therapy drugs on the horizon.
∙ Relugolix is a GnRH Antagonist, similar to Degarelix/Firmigon, but in daily tablet form. I don't suppose its side effects will be any different, although the recovery time after stopping is faster.
∙ Estradiol is an estrogen used to block Testosterone, in the form of a skin patch. This is currently being trialed as the PATCH trial. Estrogenic hormone therapy drugs can avoid some of the common hormone therapy side effects such as hot flushes and osteoporosis.

What is new is that if you start to become castrate resistant (switching off Testosterone stops working), there are now more extra drugs which can be added in to make the hormone therapy effective for longer, although you don't come off Zoladex (or whichever one you're on).

Also new is that in cases of advanced prostate cancer where you've already had radical treatment to the prostate, but now have up to 3 identifiable mets, you might be able to get some targeted treatment for them with curative intent. The cure rate isn't high, but even when it doesn't cure, it usually gives you additional time which might be free of hormone therapy.

User
Posted 25 Feb 2022 at 23:21
Thank you Andy. That is really helpful & interesting. When you say "now have up to 3 identifiable mets, you might be able to get some targeted treatment for them with curative intent", what type of targeted treatment are you referring to? RT? I currently have 2 identifiable mets (in separate lymph locations)
User
Posted 07 Apr 2022 at 10:01

Hi Andy62 - using the term “with curative intent” is of significant interest - guessing you're referring to SABR RT for identifiable mets? Could you share any source or reference material please?

Thanks!

 
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